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141. Coronavirus (COVID-19) infection and pregnancy

to blood cultures. • While pyrexia may suggest COVID-19, do not assume that all pyrexia is due to COVID-19. Consider the possibility of bacterial infection and perform full sepsis-six screening and administer intravenous antibiotics when appropriate. • Consider bacterial infection if the white blood cell count is raised (lymphocytes usually normal or low with COVID-19) and commence antibiotics. • Women should be tested for COVID-19 if they meet the inpatient or community PHE criteria. o Current

2020 Royal College of Obstetricians and Gynaecologists

142. Choosing Wisely Canada recommendation - Don’t routinely do screening mammography for average risk women aged 40 – 49. Individual assessment of each woman’s preferences and risk should guide the discussion and decision regarding mammography screening in th

of the lower spine before six weeks does not improve outcomes. Don’t use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration. Bacterial infections of the respiratory tract, when they do occur, are generally a secondary problem caused by complications from viral infections such as influenza. While it is often difficult to distinguish bacterial from viral sinusitis, nearly (...) all cases are viral. Though cases of bacterial sinusitis can benefit from antibiotics, evidence of such cases does not typically surface until after at least seven days of illness. Not only are antibiotics rarely indicated for upper respiratory illnesses, but some patients experience adverse effects from such medications. Don’t order screening chest X-rays and ECGs for asymptomatic or low risk outpatients. There is little evidence that detection of coronary artery stenosis in asymptomatic patients

2019 CPG Infobase

143. Prostate cancer screening with prostate-specific antigen (PSA) test (Full text)

guided by ultrasound Takes about 5-10 minutes Antibiotics given before procedure Local anaesthesia or sedation given before procedure May have to stop blood thinners before procedure Screening If biopsy is required Slow stream Sensation of incomplete emptying Increased urinary frequency Family history of prostate cancer African descent Poorer socio-economic groups ©BMJ Publishing Group Limited. Disclaimer: This infographic is not a validated clinical decision aid. This information is provided without

2018 BMJ Rapid Recommendations PubMed abstract

145. Developmental follow-up of children and young people born preterm

aspects of daily life. In the ICD-10 this is defined as an IQ score more than 2 standard deviations below the mean. Developmental follow-up of children and young people born preterm (NG72) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 22 of 29Neonatal sepsis Neonatal sepsis Blood culture-positive sepsis that is treated with antibiotics for more than 5 days. Small for gestational age Small for gestational age Birth

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

146. Cataracts in adults: management

. Endophthalmitis Endophthalmitis 1.8.4 Use preoperative antiseptics in line with standard surgical practice. 1.8.5 Use intracameral cefuroxime during cataract surgery to prevent endophthalmitis. 1.8.6 Use commercially prepared or pharmacy-prepared intracameral antibiotic solutions to prevent dilution errors. Cystoid macular oedema Cystoid macular oedema 1.8.7 Consider topical steroids in combination with non-steroidal anti-inflammatory Cataracts in adults: management (NG77) © NICE 2019. All rights reserved (...) #notice-of-rights). Page 22 of 235 Interventions to prevent endophthalmitis What is the effectiveness of postoperative antibiotic drops to reduce rates of endophthalmitis after cataract surgery? Wh Why this is important y this is important There is a lack of evidence on postoperative antibiotics to reduce rates of endophthalmitis, which may be because they are provided as part of standard good clinical practice in the UK. In addition, it is recognised that patients are invariably receiving other drops

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

147. Cystic fibrosis: diagnosis and management

visits and if the person with cystic fibrosis Cystic fibrosis: diagnosis and management (NG78) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 43prefers it. 1.3.7 Make arrangements (including providing equipment and expert support) for people to have intravenous antibiotic therapy at home, when this is appropriate. Multidisciplinary team Multidisciplinary team 1.3.8 The specialist cystic fibrosis (...) intravenous antibiotic services, including intravenous access. 1.3.13 Specialist physiotherapists should assess and advise people with cystic fibrosis at clinic, at inpatient admissions, during pulmonary exacerbations and at their annual review. Assessment and advice could cover airway clearance, nebuliser use, musculoskeletal disorders, exercise, physical activity and urinary incontinence. 1.3.14 Specialist dietitians should assess and advise people with cystic fibrosis about all aspects of nutrition

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

149. Spondyloarthritis in over 16s: diagnosis and management

NICE's technology appraisal guidance on ustekinumab for treating active psoriatic arthritis.] Reactiv Reactive arthritis e arthritis Antibiotics Antibiotics 1.4.30 After treating the initial infection, do not offer long-term (4 weeks or longer) treatment with antibiotics solely to manage reactive arthritis caused by a gastrointestinal or genitourinary infection. 1.5 Non-pharmacological management of spondyloarthritis 1.5.1 Refer people with axial spondyloarthritis to a specialist physiotherapist

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

150. The management of urinary incontinence in women

www.bpac.org.nz/guidelines/2 This is a bpac nz contextualisation of NICE Clinical Guideline 171 © NICE 2013 1.1.8 If women have symptoms of urinary tract infection (UTI) and their urine tests positive for both leucocytes and nitrites send a midstream urine specimen for culture and analysis of antibiotic sensitivities. Prescribe an appropriate course of antibiotic treatment pending culture results. 1.1.9 If women have symptoms of UTI and their urine tests negative for either leucocytes or nitrites send (...) a midstream urine specimen for culture and analysis of antibiotic sensitivities. Consider the prescription of antibiotics pending culture results. 1.1.10 If women do not have symptoms of UTI, but their urine tests positive for both leucocytes and nitrites, do not offer antibiotics without the results of midstream urine culture. 1.1.11 If a woman does not have symptoms of UTI and her urine tests negative for either leucocytes or nitrites do not send a urine sample for culture because she is unlikely

2019 Best Practice Advocacy Centre New Zealand

151. Gynaecologic Surgery in the Obese Patient

, surgeons should choose a minimally invasive approach to hysterectomy in obese patients, rather than laparotomy (strong, high). 9 Surgeons can consider using published weight-based dosing of cefazolin, gentamicin, and vancomycin; however, there is insufficient evidence to support re-dosing antibiotics intraoperatively or continuing postoperatively based on obesity alone (strong, low). 10 In obese patients undergoing gynaecologic surgery, surgical teams can use the Caprini score to estimate venous

2019 Society of Obstetricians and Gynaecologists of Canada

152. Management of Poisoning

reaction of massive envenomation, careful monitoring for: rhabdomyolysis, thrombocytopenia, cardiac arrhythmias, renal failure and possible dialysis should be instituted (pg 195). Grade D, Level 3 D In cases of corneal bee stings, pain relief should be provided. An urgent referral to the ophthalmologist should be done to rule out infection, uveitis and in? ammatory glaucoma. Broad-spectrum topical antibiotics could be given to prevent secondary infection. Surgical removal of the embedded stinger (...) to address the local lesion. Grade D, Level 4 D Secondary infection, chronic ulcer and osteomyelitis can occur. Prophylactic antibiotic should be given in contaminated wounds (pg 198). Grade D, Level 4 B First aid for stingray and stone? sh stings is hot, non-scalding (not higher than 45°C) water immersion as the venom is heat labile (pg 198). Grade B, Level 2++ A Hot water immersion may be useful for pain relief following jelly? sh stings after the tentacles have been removed (pg 198). Grade A, Level 1

2020 Ministry of Health, Singapore

153. Society of Interventional Radiology Quality Improvement Standards for Image-Guided Percutaneous Drainage and Aspiration of Abscesses and Fluid Collections (Full text)

. Treatment of breast abscesses with sonographically guided aspiration, irrigation, and instillation of antibiotics. AJR Am J Roentgenol . 2003 ; 181 : 1089–1091 , x 12 Levin, D.C., Eschelman, D., Parker, L., and Rao, V.M. Trends in use of percutaneous versus open surgical drainage of abdominal abscesses. J Am Coll Radiol . 2015 ; 12 : 1247–1250 , x 13 Siewert, B., Tye, G., Kruskal, J. et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol . 2006 (...) with surgical drainage of renal abscess. Int Urol Nephrol . 2007 ; 39 : 51–55 , x 11 Leborgne, F. and Leborgne, F. Treatment of breast abscesses with sonographically guided aspiration, irrigation, and instillation of antibiotics. AJR Am J Roentgenol . 2003 ; 181 : 1089–1091 , x 12 Levin, D.C., Eschelman, D., Parker, L., and Rao, V.M. Trends in use of percutaneous versus open surgical drainage of abdominal abscesses. J Am Coll Radiol . 2015 ; 12 : 1247–1250 , x 13 Siewert, B., Tye, G., Kruskal, J. et al

2020 Society of Interventional Radiology PubMed abstract

154. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children (Full text)

demonstrated that a bundled approach to initial resuscitation that includes early blood cultures is associated with improved outcomes ( , , ). If collection of the blood cultures is likely to delay administration of antimicrobial therapy to the patient, then administration of antimicrobials should take precedence, in view of the impact of delayed antimicrobial administration on patient outcomes ( ). However, because blood cultures may be the only source of information identifying bacterial antibiotic (...) sensitivities, as well as the effect of previous therapy on diagnostic yield. New molecular technologies are becoming available to facilitate earlier and faster microbiological diagnoses. Such techniques may be able to identify a range of pathogens well before blood cultures are positive ( ), and may potentially identify pathogens even after the administration of antimicrobial therapy. However, new molecular diagnostics are currently relatively expensive, are not sufficient for all pathogens and antibiotic

2020 Society of Critical Care Medicine PubMed abstract

156. Management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency

,butnotalways,low.C-reactive proteinmayberaised,butthistestisoflimitedvaluein thepostoperativeperiod. ©2020TheAuthors.AnaesthesiapublishedbyJohnWiley&SonsLtdonbehalfofAssociationofAnaesthetists 7 Woodcocket al. | Peri-operativemanagementofglucocorticoids Anaesthesia20204 Persistentpyrexiamaybeduetoadrenalinsuf?ciency, but is usually attributed to postoperative sepsis and treated with antimicrobial chemotherapy. Steroid supplementationshouldnotbereducedorwithdrawn whilethepatientispyrexial. It is clear

2020 Association of Anaesthetists of GB and Ireland

157. ASGE review of adverse events in colonoscopy

therapeutic colon procedures such as colonic stent insertion. 73 Although individual cases of infection after colonoscopy have been reported, there is no de?nite causal link with the endoscopic procedure and no proven bene?t for antibiotic prophylaxis. 74 Therefore, current guidelines from the American Heart Association and ASGE recommend against antibiotic prophylaxis for patients undergoing colonoscopy. 75 The 2016 update of the multisociety guideline on reprocessing ?exible GI endoscopes reported cases (...) options include a conservative approach, splenic artery emboliza- tion, and surgery. The treatment option chosen is based on the presentation, underlying comorbidities, and imag- ing ?ndings. Hemodynamically stable patients can be managed conservatively with close monitoring, intrave- nous ?uids, blood transfusion, and antibiotics. However, some patientsmay failaconservativeapproachandrequire surgery or splenic artery embolization. For hemodynami- cally stable patients with grades I to IV lacerations

2020 American Society for Gastrointestinal Endoscopy

158. Clinical Practice Guideline on the Diagnosis and Prevention of Periprosthetic Joint Infections

to Arthroplasty 7 Blood Tests for Preoperative Diagnosis 7 Diagnosis of Infected Joint Replacements 8 Diagnostic Imaging 9 Gram Stain 9 Avoiding antimicrobials two weeks prior to obtaining intra-articular culture to identify a pathogen for the diagnosis of PJI 9 Avoiding Initiating Antimicrobials prior to Obtaining Intra-Articular culture in patients suspected of having PJI 10 Antibiotics with low preoperative suspicion of PJI or established PJI with a known pathogen 10 Perioperative Antibiotic Selection 10 (...) 31 Blood Tests for Preoperative Diagnosis 32 Diagnosis of Infected Joint Replacements 34 Diagnostic Imaging 39 Gram Stain 42 Avoiding Antimicrobials Two Weeks Prior to Obtaining Intra-Articular Culture to Identify a Pathogen for the Diagnosis of PJI 43 Avoiding Initiating Antimicrobials Prior to Obtaining Intra-Articular Culture in Patients Suspected of Having PJI 44 Antibiotics with low preoperative suspicion of PJI or established PJI with a known pathogen 45 Perioperative Antibiotic Selection

2020 American Academy of Orthopaedic Surgeons

159. Clostridioides difficile Infection in Adults and Children

to overclassify pediatric disease as severe, hence the need for 2 or more abnormal lab criteria required to make a severe diagnosis (or the presence of a high-risk condition). The frequency of pediatric CDI patients meeting criteria for severe disease is low (~8%), with similar proportions of severe disease noted across all pediatric age groups. 63 Prevention Antibiotics and Prevention Nearly all antimicrobial classes have been associated with CDI. However, clindamycin and cephalosporins (especially third (...) The use of >14 Defined Daily Doses (DDDs) of antibiotics in the 3 months prior to CDI had the strongest association with CDI (OR 8.50;95% CI 4.56–15.9). Another study found the risk of CDI increases with cumulative dose and number of antibiotics, as well as days of antibiotic exposure. 68 Poor clinical outcomes in patients with CDI were independently associated with concomitant use of non-CDI-related antimicrobials, 69 and are associated with a doubling in risk of failure of CDI therapy. 70

2020 University of Michigan Health System

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